The Relationship Between Biomarkers of Environmental Enteric Dysfunction with Vulvovaginal Candidiasis In Pregnant Mothers and Pregnancy Outcome (Stunting): A Literature Review

Birth outcomes, including premature births and stunting, have long-term health implications. The relationship between adverse birth outcomes and asymptomatic chronic gastrointestinal inflammation (environmental enteric dysfunction - EED) has not been well-understood. EED is a subclinical inflammation of the small intestine characterized by changes in intestinal morphology, decreased absorption capacity, and impaired barrier function. Stunting is defined as a long (LAZ) / high-for-age score z > 2 elementary school under the WHO Child Growth Standards media, which remains a form of global malnutrition, affecting ∼155 million children <5 years. There are about 20% of stunting originating from the uterus which is largely driven by intrauterine growth restriction, premature birth, or both. The purpose of this systematic review is to provide an overview of the measurement of EED biomarkers in pregnant women with vulvovaginal candidiasis and pregnancy outcomes in stunting prevention. Method: This study uses a literature review design. Articles collected through Cochrane, Science Direct, Pubmed, Elseiver, Proquest (link obtained from unhas.ac.id library) Pubmed, WHO, Google Cendekia. The keywords used are environmental enteric dysfunction (EED), vulvovaginal candidiasis, pregnant women, intestinal permeability, intestinal biomarkers, L: M test. Results and Discussion: Based on the results of reviewing articles, EED biomarkers of pregnant women, specifically the L: M ratio and anti-flagellin serum and anti-LPS Igs concentrations measured at gestations ∼18 weeks, are associated with adverse birth outcomes, especially shorter pregnancy periods and reduced baby length at birth. To our knowledge, this is one of the first studies to measure EED biomarkers in a sample of pregnant women and the first to examine the relationship between EED biomarkers and pregnancy outcomes (stunting). Conclusion: The concentrations of anti-flagellin and anti-LPS of the mothers measured at ∼18 weeks of pregnancy were significantly associated with shorter pregnancies and reduction in infant length and LAZ at birth in samples of pregnant women and their newborns. These results provide preliminary evidence that maternal EED may be associated with pregnancy outcomes (stunting).